Usage
Of 74 SERUMS physicians who agreed to participate in the Telementoring program and completed the initial training, 38 (51.4%) were women and more than 70% of the participants reported no previous experience with medical applications and that 79.5% reported that they worked in health facilities located in areas of poverty and extreme poverty that depended mainly on the Ministry of Health of Peru (See Table 1).
Table 1
Characteristics of the SERUMS physicians enrolled and their healthcare facilities. Perú 2018.
Characteristics
|
N=74
|
n (%)
|
Gender
|
|
|
Female
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38 (51.4)
|
|
Male
|
36 (48.7)
|
Previous use of medical apps
|
|
No
|
52 (70.3)
|
|
Yes
|
15 (20.3)
|
|
Does not respond
|
7 (9.5)
|
Poverty quintile
|
|
|
Quintile 1 (poorest)
|
58 (79.5)
|
|
Quintile 2
|
13 (17.8)
|
|
Quintile 3
|
2 (2.7)
|
Resolution Level of the H.F.
|
|
I-1
|
15 (20.6)
|
|
I-2
|
44 (60.3)
|
|
I-3
|
14 (19.2)
|
Dependency of the H.F.
|
|
|
Ministry of Health
|
55 (75.3)
|
|
Social security (EsSalud)
|
13 (17.8)
|
|
National Police Department
|
2 (2.7)
|
|
National Armed Forces
|
3 (4.1)
|
Geographic location of the H.F.
|
|
Coastal regions
|
10 (13.7)
|
|
Highland regions
|
59 (80.9)
|
|
Jungle regions
|
4 (5.4)
|
H.F.: Healthcare Facility
|
Only 12 (16.2%) of physicians enrolled used the program, that is, made inquiries or questions to the mentors. A total of 27 consultations were carried out, with a mean of 2.1 ± 1.3 consultations for each physician. All queries were answered. The majority (62.5%) were answered in less than six hours and were mainly related to the topics of dermatology (40.7%), legal medicine (14.8%) and cardiology (11.1%). (See Table 2)
Table 2
Characteristics of the utilization of the Telementoring program on young physicians in rural areas. Perú 2018
Characteristics
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N=27
|
n (%)
|
Average of response time (hours)
|
5.4 ± 6.3
|
Mentoring areas
|
|
|
Dermatology
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11 (40.7)
|
|
Legal Medicine
|
4 (14.8)
|
|
Cardiology
|
3 (11.1)
|
|
Pediatrics
|
2 (7.4)
|
|
Endocrinology
|
1 (3.7)
|
|
Infectology
|
1 (3.7)
|
|
Neonatology
|
1 (3.7)
|
|
Neurology
|
1 (3.7)
|
|
Ophthalmology
|
1 (3.7)
|
|
Otorhinolaryngology
|
1 (3.7)
|
Response time
|
|
|
<6 hours
|
15 (62.5)
|
|
6-12 hours
|
3 (12.5)
|
|
>12 hours
|
6 (25.0)
|
Average queries by physician
|
2.1 ± 1.3
|
Regarding the interviews carried out, we explored the ease of use and usability of the system among physicians who used the Telementoring program, and we explored the main reasons for not using the system among those who did not use the system during the study period. (See Figure 2)
Easy to use
SERUMS physicians who used the program reported that was easy to use because it was intuitive and similar to other instant messaging systems, they were more familiar with, such as WhatsApp groups. Also, due to the possibility of sharing a specific consultation in a structured way by attaching multimedia files, which were necessary for consultations with some specialties such as dermatology or pediatrics.
“I think it is a good tool to help us in our medical work. Especially for some clinical issues since in the group chat, we could share some clinical data in a structured way and images in good resolution.” (Participant 7).
However, it was also reported that some physicians found it difficult to use other features such as starting a personal chat, notification settings, etc. For this, the need for additional training was raised due to the little previous experience of some physicians in the use of medical applications.
“Almost all individual questions were done in the group chat. I didn’t really know how to use personal chat because it wasn’t very clear to me in the initial training and I’m not very familiar with apps. On certain occasions I would have liked to ask questions in private.” (Participant 1).
Usability
It was reported that the system was of great help in resolving cases since, due to the physicians’ lack of experience, they were not clear on how to act in certain situations. Also, because the queries of others could be seen in the chat, and served as learning material to develop skills to solve similar problem situations.
“It has been an important and useful tool because in some specific issues we had inexperience. Especially since we are working at the first level of care, and we do not receive specific training for some situations here… It was also useful when you share and see the cases of your colleagues, it encourages you to think about similar problems, you learn from it.” (Participant 4) .
Additionally, it was mentioned that the response time of the questions played an important role. Although they initially expected responses to be immediate, given the nature of the program (not used for urgent/emergencies) and given the limited availability of specialists, most agreed that the time delay was adequate.
“When I joined the program, I was inexperienced, so I was encouraged to consult ... now I have more knowledge in these aspects, for example, how to act when faced with an autopsy request for a legal medical problem ... The program it is especially useful in the first months of SERUMS.” (Participant 10).
Reasons for not using the system
It was reported that although it would have been very helpful to have the opinion of a specialist physicians or a university professor, recent graduated physicians did not ask questions because they had a certain degree of embarrassment and fear of appearing foolish or inexperienced to other colleagues. It was reported that they would prefer no group chats, only direct communications, and that it would be good for some not to show their full name but an alias.
“It seemed that those who did write in the groups put really difficult cases… and it was embarrassing to write simple questions. I know of a friend who sometimes had questions but didn’t want to show that he didn’t know because they could later identify him with his full name. In the case of us (physicians)... even more so, we are too proud to admit it.” (Participant 2).
Another reason was because they started accessing the program late when they had already obtained enough experience to solve most of the frequent doubts on their own. The reason for this was that they had never participated in a similar telehealth program before and did not fully understand how it worked. Most agreed that the program should be prioritized in the first months of social service.
“In my case at this point I have no longer had any doubts about cases. That would be the main reason why I did not have the need to consult or present a clinical case. It would have been especially helpful at the beginning of SERUMS when we were adapting”. (Participant 4).
Other reasons referred by SERUMS physicians were related to technical aspects. Internet bandwidth was mentioned to be a main issue, being in most cases of poor quality or simply inaccessible for some settings. Also, some physicians mentioned they did not desire to install new mobile-phone apps, instead they preferred and use frequently commercial messaging apps, such as WhatsApp, to performed clinical queries to their peers.
“I do not use the application because of the internet problem… The truth is that the connection was bad almost all last year, only calls or text messages came in” (Participant 13).